The significance of the morphology-voltage-P-wave duration (MVP) ECG score for prediction of in-hospital and long-term atrial fibrillation in ischemic stroke

Introduction: Prolonged P-wave duration (PWD) is associated with paroxysmal atrial fibrillation (AF), which might be underdiagnosed in ischemic stroke patients, in whom it might be pivotal for initiation of secondary prevention oral anticoagulation therapy. We aimed to assess whether PWD predicts new-onset AF during 10-year follow-up in ischemic stroke patients compared to control subjects enrolled in the Lund Stroke Register (LSR). Methods: Study sample comprised of 227 first-ever ischemic stroke patients without AF (mean age 72±12 y, 92 female) and 1:1 age- and gender- matched control subjects without stroke and AF enrolled in LSR from Mar 2001 to Feb 2002. The date of new-onset AF during follow-up was assessed by the date of first AF ECG in the regional ECG database and by record linkage with the Swedish National Patient Register. The available standard snapshot 12-lead sinus rhythm ECGs at baseline were retrieved from electronic database and digitally processed. Results: Patients with ischemic stroke compared to controls more often had hypertension (57% vs 31%), diabetes (15% vs 7%) and vascular diseases (42% vs 13%, all p < 0.005). New-onset AF was detected in 39 (17%) stroke patients and in 30 (13%) controls, p=0.296. In the multivariate Cox regression analysis, new onset AF in the stroke group was associated with age>65 years (HR=3.78, 95%CI 1.32-10.85, p=0.013) and hypertension (HR=2.42, 95%CI 1.09-5.40, p=0.030), but not with PWD. On the contrary, PWD>120 ms was the only independent predictor of new onset AF in the control group after adjustment for age and cardiovascular risk factors (HR=3.36, 95%CI 1.41-8.01, p=0.006, Figure 1). Conclusions: Prolonged P-wave duration is the strongest predictor of AF incidence during 10-year follow-up in stroke-free population. However, in ischemic stroke patients the developing of AF is more likely associated with more advanced cardiovascular comorbidities than with electrical abnormalities in the heart.

Download Full-text

Signal-averaged P wave duration and the long-term risk of permanent atrial fibrillation

Scandinavian Cardiovascular Journal ◽

10.1080/14017430701652282 ◽

2008 ◽

Vol 42 (1) ◽

pp. 31-37 ◽

Cited By ~ 10

Author(s):

Ulrik Dixen ◽

Mette Vang Larsen ◽

Lasse Ravn ◽

Jan Parner ◽

Gorm B. Jensen

Keyword(s):

Atrial Fibrillation ◽

P Wave ◽

Wave Duration ◽

P Wave Duration ◽

Permanent Atrial Fibrillation

Download Full-text

A comparison of P-wave duration and dispersion in patients with short-term and long-term atrial fibrillation

Journal of Electrocardiology ◽

10.1016/s0022-0736(03)00049-9 ◽

2003 ◽

Vol 36 (3) ◽

pp. 251-255 ◽

Cited By ~ 20

Author(s):

Abdullah Dogan ◽

Gurkan Acar ◽

Omer Gedikli ◽

Mehmet Ozaydin ◽

Cem Nazli ◽

...

Keyword(s):

Atrial Fibrillation ◽

P Wave ◽

Short Term ◽

Wave Duration ◽

P Wave Duration

Download Full-text

Prolonged Signal -Averaged P-Wave Duration and the Long-Term Risk of Permanent Atrial Fibrillation

EP Europace ◽

10.1016/j.eupc.2005.08.070 ◽

2005 ◽

Vol 7 ◽

pp. S27-S27

Author(s):

U DIXEN ◽

L RAVN ◽

M LARSEN ◽

J PARNER ◽

G JENSEN

Keyword(s):

Atrial Fibrillation ◽

P Wave ◽

Wave Duration ◽

P Wave Duration ◽

Permanent Atrial Fibrillation

Download Full-text

Usefulness of P Wave Duration in Embolic Stroke of Undetermined Source

Journal of Clinical Medicine ◽

10.3390/jcm9041134 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1134

Author(s):

Moonki Jung ◽

Jin-Seok Kim ◽

Ju Hyeon Song ◽

Jeong-Min Kim ◽

Kwang-Yeol Park ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Holter Monitoring ◽

Embolic Stroke ◽

P Wave ◽

Stroke Recurrence ◽

Wave Duration ◽

P Wave Duration ◽

Potential Association

The investigation of the potential association between ischemic stroke and subclinical atrial fibrillation (SCAF) is important for secondary prevention. We aimed to determine whether SCAF can be predicted by atrial substrate measurement with P wave signal-averaged electrocardiography (SAECG). We recruited 125 consecutive patients with embolic stroke of undetermined source (ESUS) and 125 patients with paroxysmal atrial fibrillation as controls. All participants underwent P wave SAECG at baseline, and patients with ESUS were followed up with Holter monitoring and electrocardiography at baseline, 3, 6, and 12 months after discharge and every 6 months thereafter. In the ESUS group, 32 (25.6%) patients were diagnosed with SCAF during follow-up. There were no significant differences between the groups regarding atrial substrate. P wave duration (PWD) was a significant predictor of SCAF. Stroke recurrence occurred in 22 patients (17.6%), and prolonged PWD (≥ 135 ms) predicted stroke recurrence more robustly than SCAF detection. In ESUS patients, PWD can be a useful biomarker to predict SCAF and to identify patients who are more likely to have a recurrent embolic stroke associated with an atrial cardiopathy. Further research is needed for supporting the utility and applicability of PWD.

Download Full-text

Advanced interatrial block precedes atrial fibrillation and stroke. The prospective interatrial Block And Yearly EventS (BAYES) registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.0485 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Martinez-Selles ◽

R Elosua ◽

M Ibarrola ◽

M De Andres ◽

P Diez-Villanueva ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Disease ◽

Sinus Rhythm ◽

Structural Heart Disease ◽

P Wave ◽

Wave Duration ◽

P Wave Duration ◽

Previous Diagnosis ◽

Surface Ecg ◽

Interatrial Block

Abstract Background Advanced interatrial block (IAB), prolonged and bimodal P waves in surface ECG inferior leads, is an unrecognized surrogate of atrial dysfunction and a trigger of atrial dysrhythmias, mainly atrial fibrillation (AF). Our aim was to prospectively assess whether advanced IAB in sinus rhythm precedes AF and stroke in elderly outpatients with structural heart disease, a group not previously studied. Methods Prospective observational registry that included outpatients aged ≥70 years with structural heart disease and no previous diagnosis of AF. Patients were divided into three groups according to P-wave characteristics. Results Among 556 individuals, 223 had normal P-wave (40.1%), 196 partial IAB (35.3%), and 137 advanced IAB (24.6%). After a median follow-up of 694 days; 93 patients (16.7%) developed AF, 30 stroke (5.4%), and 34 died (6.1%). Advanced IAB was independently associated with AF (hazard ratio [HR] 2.9, 95% confidence interval [CI] 1.7–5.1, p<0.001), stroke (HR 3.8, 95% CI 1.4–10.7, p=0.010), and AF/stroke (HR 2.6, 95% CI 1.5–4.4, p=0.001). P-wave duration (ms) was independently associated with AF (HR 1.05, 95% CI 1.03–1.07, p<0.001), AF/stroke (HR 1.04, 95% CI 1.02–1.06, p<0.001), and mortality (HR 1.04, 95% CI 1.00–1.08, p=0.021). Conclusions The presence of advanced IAB in sinus rhythm is a risk factor for AF and stroke in an elderly population with structural heart disease and no previous diagnosis of AF. P-wave duration was also associated with all-cause mortality. Figure. Age- and sex-adjusted linear and non-linear association between P-wave duration (msec) and atrial fibrillation (A), stroke (B), and atrial fibrillation or stroke (C) risk. Results of a generalized additive model with spline smoothing functions and 4 degrees of freedom. Figure 1. Kaplan-Meyer curves of survival free of atrial fibrillation (A), stroke (B) and atrial fibrillation or stroke (C) in patients with normal P-wave, partial interatrial block (IAB) and advanced IAB. Funding Acknowledgement Type of funding source: None

Download Full-text

B-AB16-03 P WAVE PARADOX: CAN THE P WAVE DURATION ON 12 LEAD ELECTROCARDIOGRAPHY INFORM ATRIAL FIBRILLATION RECURRENCE AFTER CATHETER ABLATION

Heart Rhythm ◽

10.1016/j.hrthm.2021.06.094 ◽

2021 ◽

Vol 18 (8) ◽

pp. S31-S32

Author(s):

Michael Gardner ◽

Shruti Bidani ◽

Muzammil Khan ◽

Jianhui Zhu ◽

William W. Barrington ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

P Wave ◽

Atrial Fibrillation Recurrence ◽

Wave Duration ◽

P Wave Duration

Download Full-text

Signal-averaged P wave duration in patients with atrial fibrillation treated with radiofrequency catheter ablation

Heart Rhythm ◽

10.1016/j.hrthm.2005.02.570 ◽

2005 ◽

Vol 2 (5) ◽

pp. S182-S183

Author(s):

Brian Nilsson ◽

Ulrik Dixen ◽

Xu Chen ◽

Steen Pehrson ◽

Jesper H. Svendsen

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Radiofrequency Catheter Ablation ◽

P Wave ◽

Wave Duration ◽

P Wave Duration

Download Full-text

The effect of diabetic autonomic neuropathy on P-wave duration, dispersion and atrial fibrillation

Archives of Medical Science ◽

10.5114/aoms.2011.25555 ◽

2011 ◽

Vol 5 ◽

pp. 806-812 ◽

Cited By ~ 14

Author(s):

Andrzej Bissinger ◽

Tomasz Grycewicz ◽

Wlodzimierz Grabowicz ◽

Andrzej Lubinski

Keyword(s):

Atrial Fibrillation ◽

Autonomic Neuropathy ◽

Diabetic Autonomic Neuropathy ◽

P Wave ◽

Wave Duration ◽

P Wave Duration

Download Full-text

An Atrial Fibrillation with Normal Limits using Signal Processing- A Review

International Journal of Engineering & Technology ◽

10.14419/ijet.v7i2.24.12133 ◽

2018 ◽

Vol 7 (2.24) ◽

pp. 453

Author(s):

S. Sathish ◽

K Mohanasundaram

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Normal Sinus Rhythm ◽

P Wave ◽

Wave Duration ◽

Normal Limits ◽

Normal Sinus ◽

P Wave Duration ◽

Standard Lead ◽

Wave Morphology

Atrial fibrillation is an irregular heartbeat (arrhythmia) that can lead to the stroke, blood clots, heart failure and other heart related complications. This causes the symptoms like rapid and irregular heartbeat, fluttering, shortness of breath etc. In India for every around 4000 people eight of them are suffering from Atrial Fibrillation. P-wave Morphology. Abnormality of P-wave (Atrial ECG components) seen during sinus rhythm are associated with Atrial fibrillation. P-wave duration is the best predictor of preoperative atrial fibrillation. but the small amplitudes of atrial ECG and its gradual increase from isometric line create difficulties in defining the onset of P wave in the Standard Lead Limb system (SLL).Studies shows that prolonged P-wave have duration in patients (PAF) In this Study, a Modified Lead Limb (MLL) which solves the practical difficulties in analyzing the P-ta interval for both in healthy subjects and Atrial Fibrillation patients. P-Ta wave interval and P-wave duration can be estimated with following proposed steps which is applicable for both filtered and unfiltered atrial ECG components which follows as the clinical database trials. For the same the p-wave fibrillated signals that escalates the diagnosis follows by providing minimal energy to recurrent into a normal sinus rhythm.

Download Full-text